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Mental health, drug abuse care among remaining Florida budget concerns

Naples Daily News - 4/30/2017

April 30--TALLAHASSEE -- The budget deal under negotiation in the final days of Florida's legislative session would cut $651 million in Medicaid payments to hospitals, which advocates argue could spell disaster for mental health patients.

To work within the proposed $34.2 billion health care budget tentatively agreed to by Senate President Joe Negron and House Speaker Richard Corcoran, the Senate had to cut more than $1.2 billion from its proposed health care plan by slashing another $392.7 million in state-federal Medicaid money to hospitals and another $607.8 million it had allocated to hospitals that care for poor patients.

The total proposed health care budget for next year would decrease spending slightly from the current $34.3 billion. The Medicaid and hospital cuts would be offset by increased spending in other areas, including programs for children, the elderly, health centers and lawmakers' projects.

The health subcommittee budget chairs are finished with their talks. But a number of items remain unresolved in the negotiations, which have happened over a shorter period of time compared to past budget conferences.

Left unresolved are:

* How to handle up to $1.5 billion in potential state and federal funding for hospitals that take care of poor patients.

* How to implement hospital cuts.

* How many state employees to cut from the health programs.

* Specific lawmaker projects to approve.

Those issues will be decided by the budget committee chairmen in the House and Senate.

Currently, the state's agency for health care is negotiating terms with President Donald Trump's administration for the additional $1.5 billion in state-federal funding that would be given to hospitals.

Related stories:

* Federal funds for hospitals could free up money for budget negotiations

* Florida House health care policies stall in the Senate

* Some Florida hospitals have ignored House request for financial disclosures

* Federal agency offers Florida money to help care for poor in hospitals

That money isn't included in the broad $83 billion budget deal being negotiated now. Lawmakers have until Tuesday to finish the proposed budget to end the session on time Friday.

Sen. Anitere Flores, who chairs the Senate health appropriations committee, said she is hopeful the final terms for the federal money will be worked out by Monday.

The state's health agency "continues to give us all indications that in working with the federal government, they should have a solution at least on some parameters by the time that Monday rolls around," said Flores, R-Miami.

If that happens, legislative leaders will have to decide whether they want to amend the state health care agency's budget to include the $1.5 billion.

Flores said she wanted to use some of that money to help hospitals that are facing $651 million in total Medicaid cuts, which hospital and mental health advocates argue will exacerbate what they say is Florida's mental health crisis.

"If you are cutting resources for hospitals, then you are creating a larger demand on your mental health safety net system," said Natalie Kelly, who oversees a statewide organization for mental health and treatment of substance abuse.

Kelly said the state passed a landmark law last year, SB12, that developed a comprehensive system for treating mental health patients. The law included $10 million for health crisis centers called centralized receiving facilities that function as alternatives to hospital emergency rooms for patients in crisis.

She called the measure a "no-wrong-door" approach for individuals in need of mental health and substance abuse care.

"This no-wrong-door approach includes central receiving facility systems in each area of Florida, coordination of care of individuals with the most need, including those coping with opiate issues, and housing opportunities. Unfortunately, the Legislature did not fund these initiatives for this coming fiscal year," Kelly said.

Click here to get complete coverage of the Florida legislative session ยป

The state's mental health system, referred to as "managing entities," is a "model for the nation," Kelly said, and the Legislature needs to fund it.

Rep. Jason Brodeur, chairman of the House health appropriations committee, said policies included in the new law weren't the "be all, end all" for mental health care throughout the state. He cited two other mental health projects the state is funding, as well as some legislative projects.

"I certainly wouldn't be opposed to revisiting the entire issue statewide to see if there isn't a better mechanism to deliver those services in a more consistent and more comprehensive manner," said Brodeur, R-Sanford. "We're funding (mental health) at the level that we can."

The Senate wanted $10 million to deal with the state's opioid crisis, but Flores said she was uncertain where the money would come from and that the House has yet to agree to it.

Rep. Kathleen Peters, who has been a leading advocate for mental health and was a force behind the legislation, said there isn't enough mental health funding in next year's budget. She said she is trying to secure money to attract federal aid and assist with implementing the program before budget negotiations are finished.

"Local member programs aren't going to cut it," said Peters, R-South Pasadena. "On average, more than one-third of all emergency room visits are associated with mental illness and addiction."

Keith Arnold, a hospital lobbyist, said Florida's hospitals often treat mental health patients through their emergency rooms because these patients don't have access to other options.

"It's long been known that because of a lack of services for those suffering from mental and behavioral health, those patients show up in the emergency room for primary health care needs," Arnold said.

Tony Carvalho, president of the Florida Safety-Net Alliance, said if the Legislature continues to cut reimbursement rates to Medicaid for hospitals, some will start dropping their contracts with Medicaid providers.

"Some hospitals will start reconsidering their relationship with Medicaid managed-care providers," Carvalho said. "If they continue to cut reimbursement to Medicaid, access to care will be challenged."

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(c)2017 the Naples Daily News (Naples, Fla.)

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